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Home My WebLink About1965 DEERGRASS WAY; 122; CB023257; PermitI/ 6? \ ' 10-29-2002 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No Building Inspection Request Line (760) 602-2725 CB023257 Job Address Permit Type Parcel No Reference # Project Title 1965DEERGRASSWYCBADSt 122 ELEC 2550121600 Lot# LA COSTA GLEN-ADD 4 CEILING FANS Status ISSUED Applied 10/29/2002 Entered By RMA Plan Approved 10/29/2002 Issued 10/29/2002 Inspect Area Applicant POLMEX CONSTRUCTION PMB 104 14871 POMERADO RD 92064 858 565-7789 Owner CONTINUING LIFE COMMUNITIES LLC C/O RICHARD ASCHENBRENNER 800 MORNINGSIDE DR FULLERTON CA 92835 Total Fees $2000 Total Payments To Date $000 02 20.00 Electric Issue Fee Single Phase per AMP Three Phase per AMP Three Phase 480 Per AMP Remodel/Alteration per AMP Remodel Fee Temporary Service Fee Test Meter Fee Other Electrical Fees Additional Fees TOTAL PERMIT FEES 0 0 0 0 $1000 $000 $000 $000 $000 $1000 $000 $000 $000 $000 $2000 Inspecto FINAL.AR« Date . fRO> £2 Clearance NOTICE Please take NOTICE that approval of your project includes the "IrnKisition" / fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions" You have 90 days from the date this permit was issued to protest imposition of these fees/exactions If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and We the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3 32 030 Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any fees/exactions of whichyou have previously been aiven a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 Jl,:u PROJECT INFORMATION FOR OFFICE USE O PLAN CHECK NO y03-3257 EST VAL Plan Ck Deposit Validated By Date Address (include Bldg/Suite #) 0 Business Name (at this address) Legal Description Assessor's Parcel #f^-j^^a nJr/.i Description of Work Lot No Subdivision Name/Number Unit No Phase No Total tt of units Existing Use Proposed Use b^a- ItfOK L /^ r? 2- SO FT f f f 1#of Stories / # of Bedrooms tt of Bathrooms SON. (if different, from applicant) Name Address City 3.? APPLICANT nj'Cantractor H Agent for Contractor f] Owner Q Agent for Owner^»—-t^"' 'v "• ^^ "' " , »" ' '" ..—~. •' * j* i «—• KO I/V\ •»" V? LllVl "^-kv 11J JH esrt l^-tlSl State/Zip CA Telephone «Fax tt Name 4 "-PROPERTY OWNER Address City ' State/Zip rJJj had Telephone # Name Address <^ £y City State/Zip Telephone # 5V1 CONTRACTOR -COMPANY NAME""r"v; " ,,\ ,^ • ' "W"r:" "•.? ; ;._ : :.:,' ; _ ;:, .-,.-• •;..;••. -.; ,, _,,-,' (Sec 7031 5 Business and Professions Code Any City or County which requires a permit to construe t, alter, improve, demolish or repair any structure; prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged exemption Any violation of Section 7031 5 by any applicant for a pjgrmit subjects the applicant to a ciyjj penalty of not more than five hundred dollars [$500]) <*(/ Name State License tt Address License Class City State/Zip Telephone # City Business License # / 2-1 ^rUOCf Designer Name Address City State/Zip Telephone State License tt 6 WORKERS'COMPENSATION ""'.'." "'."' "' -"••'•• ..""'!ff,!t- ^t^'V^I^ .;•>•' "'~~f~ T- '""""' • >" ' '": ."' • Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations GJ I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued Iv'f I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued My worker's compensation insurance earner and policy number are Insurance Company ZyTZOTtg- "Tjlj ju^\ rx Policy No / ti-Lc>^\ II Q Q "£ Expiration Date_ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) l~l CERTIFICATE OF EXEMPTION I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California WARNING Failure to secure workers compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition tff the cost of comperfe&tion damages as provided for in Seel ion 3706 of the Labor code, interest and attorney's fees SIGNATURE ) <•*- ti*-? t- (/ j / fo^T'"<-^ DATE /^) ' ~&'j *~ O <£•*"" 7 OWNER-BUILDER DECLARATION ~^;.-, ;., . ': A,*;! * -i::i , I hereby affirm that I am exempt from the Contractor s License Law for the following reason Q I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec 7044, Business and Professions Code The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended cr offered for sale If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale) 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec 7044, Business and Professions Code The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law) n I am exempt under Section Business and Professions Code for this reason 1 I personally plan to provide the major labor and materials for construction of the proposed property improvement l~l YES CD NO 2 I (have / have not) signed an application for a building permit for the proposed work 3 I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number) 4 I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number / contractors license number) 5 I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work) PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY '".,""" '.." f .„ - £ = Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley Tanner Hazardous Substance Account Act? Q YES C] NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? f~1 YES l~l NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? O YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT 8' J CONSTRUCTION LENDING AGENCY-:" -'"- i °: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(i) Civil Code) LENDER'S NAME LENDER'S ADDRESS 9.*i: APPLICANT CERTIFICATION . .;* ••••. ' , : I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate I agree to comply with all City ordinances and State laws relating to building construction I hereby authorize representatives, of the City of Carlsbad to enter upon the above mentioned property for inspection purposes I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT OSHA An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height EXPIRATION Every permit issued bythgJiude'ifKj-efficial under the proviSions~3HkMS Code shall expire by limitation and become null and void if the building or work authorized by such permit is not,cofntfienced withinrl«0 days friAi the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the workjerCommenced for^petiod of 180 days (Section 106 4 4 Uniform Building Code) f \s ~*5>*r ; , . /APPLICANT'S SIGNA DATE WHITE File YELLOW Applicant PINK Finance Inspection Last Permit* CB023257 Type ELEC LA COSTA GLEN-ADD 4 CEILING FANS pate Inspection Item Inspector, Act Comments 03/13/200339 Final Electrical PS AP 11/19/200234 Rough Electric PS AP Friday, March 14, 2003 Page 1 of 1 VUJLCl ~> 3 Bedroom/2 Bath • 1608 sq.ft. •*^ i;-.,.,. ; .. - .'' . .„-?•,-• . i^ig * -H*'At* <.•!(.,£,, 'T ,• rv - '. . ^»- -,--.•••- ' - • ,^---| --^T-^^La Costa <jlen' " CEILING FANS VILLA 122 1965 DEERGRASS WAY Master Bedroom IfiMTx !2'-6" ttttssa 02/01 OCT 2 9 2002 City of CARLSBAD ^^ 0 Continuing Life Communities reierves the right to change product design, options prices, and terms without prior nonce Continuing Iffi 'ComAiiifihtes fci& aba la Costa Glen Carlsbad, has filed a licensing application with and has been issued a permit to sell Deposit Subscription Agreements by the State of California. Department of Social Services, Continuing Care Branch. so COMPENSATION NSURANCE PO BOX 807, SAN FRANCISCCXCA 94101-0807 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE 08-01-02 -;.:., , POLICY NUMBER '1264119 -. 02 ;>;; , CERTIFICATE EXPIRES!.08-01-03 : CONTRACTORS STATE LICENSE BOARD ATTN: WORKERS' COMP. UNIT .." BOX 26000' SACRAMENTO CA 95826, JOB: LIC #351217 / INCEPTION DATE 08-01-02 DO. SAN DIEGO This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer We will also give you 30 days' advance notice should this'policy be cancelled prior to its normal expiration > ' This certificate of insurance'is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions> of such policies EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS.- $1,000.000 00 PER OCCURRENCE STANDARD EXCLUSION INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY , ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08/01/02 IS ATTACHED TQ AND FORMS A PART OF THIS POLICY EMPLOYER LEGAL NAME POLMEX CONSTRUCTION . PMB #104 ' - • . H*78l POMERADO RD # 10V: POWAY CA 92064. V VILLARREAL, RUDY L. ''" PRINTED 07-17-02 P0409 SCIF, 10285 (REV. 2-01) SURETY COMPANY of the PACIFIC p-00»,OJ89 RATED EXCELLENT by A.M. BEST • TREASURY LISTED 6345 BALBOA BOULEVARD, BUILDING 2. SUITE 325 / ENCINO, CALIFORNIA 91316 1617 TELEPHONE (81 8(609 9232 To: March 6, 2002 RE: Contractors License Bond: 6020368 To Whom at May Concern, Surety Company of the Pacific issued the above mentioned contractor's license bond for: Principal: Polmex Construction Original Effective Date, 7/2/95 Current Bond Renewal Term; 7/1/01 - 7/1/03 Contractor's License Number: 351217 The aforementioned statutory $7,500 contractor's state license bond is written pursuant to section 7071.6 of the California Business and Professions Code. For the Registrar of Contractor's present status of this bond, please contact the Contractor's State License Board at (916) 255-3900 or (800) 321-2752. Sincerely, Kathy K. Goodwin CL Underwriting LICENSE OD49985 THIS LICENSE HAS A TRUE DOCUCHECK™ WATERMARK AND VISIBLE FIBERS DISCERNIBLE FROM BOTH SIDES , -calficate Is no! tan endorsement ncrcertificalion of compliance !> .cf-• ^POLMEX'CONSIRUCTION ;iX i? ^' "iJ:\c?''^, _ V V V" V V ,V -V _ V _ V- f-V- V V .. V , ' v . _ etiiAiUNis ADDRESS '<<£'',,^4781 iPOMERADO.Rb^'l'o^' ^ *''"' ^ '<£*''' £$*' ^f"1,* fv ': Ct"" O* f"'-*1 f1** ^ £"'* ^ ''"^ ^'%*' C^1' fv Cv ~£*V' t'v* f'v t T1 ' rs* *•* v .• ' v' i> ! j- n^"\\A/ A\/ /"^'A' f\O/\O>1'"'OOr\O r ' ' j* ' -^ ' * s s ••.eiTY-ANCI STATE '.tip • '.'.& POW AY, Cfy, 92064-2802 :<> -.<• ^y s<fc, St, ^ ,«,. y-0 ..